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Recognizing Value In and

Realizing Value From Health

InformationTechnology

Authors: Joan McQueen, Angela Robinson, Rebekah Ruyts, Pam Shirley and Tak Tang

Topics Covered

• Recognizing Value In Health Information Technology (HIT)

– History– Benefits and Risks– Electronic Health Records– Personal Health Records– E-Prescribing– Health Information Exchange– Telemedicine– Wireless Technology

Topics Covered (cont’d)

• Realizing Value From Health Information Technology (HIT)

– Benefits Measurement Program– ROI (Return on Investment) vs. Value

• New Capabilities in Health Information Technology (HIT)

– Electronic Health Records (EHRs)– Computer/robotic solutions– Public service aspects of Health Information

Exchanges (HIEs)

Recent history of HIT:

The Institute of Medicine’s (2001) call for the use of electronic prescribing systems in all healthcare organizations by 2010 heightened the urgency to accelerate United States hospitals’ adoption of Computerized Physician Order Entry (CPOE) systems.

In 2004, President Bush signed an Executive Order titled the President’s Health Information Technology Plan, establishing a ten-year plan as this technology is essential to put the needs and the values of the patients first and gives patients information they need to make clinical and economic decisions.

Recognizing Value in HIT

With healthcare costs and quality assurance taking priority

in patient care, increased attention has been focused

towards the potential of HIT to lower health care

expenses, improve efficiency, quality, and safety of

healthcare delivery.

Some of those improvements include:

Electronic Health Records Personal Health Records E-Prescribing Health Information Exchange


According to the Health and Human Services Recovery Program:

“Recovery funding has been designated to

modernize the health care system by promoting and

expanding the adoption of health information

technology by 2014. Achieving this goal will reduce

health costs for the federal government by over $12

billion over the next 10 years.”

-From HHS.GOV


General benefits of HIT

•Elimination of chart-pulling, chart-filing, chart loss.

•Easy electronic review of patient information before visits.

•Notification of completed diagnostics and labs to review.

•Notification of required follow-ups, tests, etc.

•Improved timeliness of care team communications.


General benefits of HIT (cont’d)

•Potential reduction in medical errors with decision support systems and easier access to relevant information

•Reduction in prescription errors and subsequent time lost communicating with pharmacies.

•Reduction of adverse drug reaction/ interactions via immediate access to drug-drug and drug-food interaction alerts.


General benefits of HIT (cont’d)

•Easy communication with patients’ other providers, specialists, hospital visits, etc.

•More complete and detailed information available for claims, malpractice suits, etc.

•Potential reduced costs for labor and supplies related to charts and chart maintenance.

•Improved flow of information between staff members.


General risks of HIT

•Workflow disruption. Decreased productivity.

•Costly set-up and costly maintenance.

•Lack of adequate funding can jeopardize completion of projects.

•Low technological competence among staff — problems with adjustment, fear of change.


General risks of HIT (cont’d)

•Perceived unhappiness among patient population — “you talk to the computer, not me.”

•Technical limits in your practice (no high-speed connection, etc.).

•Chosen Health IT product doesn't adequately fit needs (e.g., have to double-document or sustain paper-based processes and electronic processes).


Electronic Health Records


“The Electronic Health Record (EHR) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR automates and streamlines the clinician's workflow. The EHR has the ability to generate a complete record of a clinical patient encounter - as well as supporting other care-related activities directly or indirectly via interface - including evidence-based decision support, quality management, and outcomes reporting.”

--HIMSS, 2009

Personal Health Records


“The PHR is a tool that you can use to collect, track and share past and current information about your health or the health of someone in your care. Sometimes this information can save you the money and inconvenience of repeating routine medical tests. Even when routine procedures do need to be repeated, your PHR can give medical care providers more insight into your personal health story.”

-myPHR.com

Personal Health Records (cont’d)


Important points to remember about a Personal Health Record:

•PHRs are owned and updated by the healthcare consumer, not the provider. The information can be electronically shared with care providers as the consumer has determined it’s usefulness to their care.

•You should always have access to your complete health information.

Personal Health Records (cont’d)

Important points to remember about a Personal Health Record:

•Information in your PHR should be accurate, reliable, and complete.

•You should have control over how your health information is accessed, used, and disclosed.

•A PHR may be separate from and does not normally replace the legal medical record of any provider.


E-Prescribing

More than an electronic medium, e-Prescribing improves the management of patient drug histories and provides immediate access to decision-support information at the point of care delivery. It accomplishes this by:

• Eliminates handwriting issues.

• Creates electronic records to ensure prescription information is not lost.


E-Prescribing (cont’d)

•Improves data exchange between prescribers and pharmacists.

• Expedites prescription refill requests and medication delivery.

• Reduces costs by improving work efficiency and identifying less expensive drug options.


E-Prescribing (cont’d)

• Checks for allergies, drug-drug interactions, dosing errors, therapeutic duplication, pregnancy-related issues and other patient-specific factors.

• Maintains an accurate, comprehensive drug database.

• Provides up-to-date formulary and insurance information.


Health Information Exchange (HIE)

The terms “RHIO” and “Health Information

Exchange” or “HIE” are often used interchangeably.

RHIO (regional health information organization) are

a group of organizations with a business stake in

improving the quality, safety and efficiency of

healthcare delivery.


Health Information Exchange (HIE) (cont’d)

The goal of HIE is to:

•Facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, effective, equitable, patient-centered care.

•HIEs also provide the infrastructure for secondary use of clinical data for purposes such as public health, clinical, biomedical, and consumer health informatics research, as well as institution and provider quality assessment and improvement.


Recognizing Value in HITTelemedicine

A general term used to describe the ability of

telecommunication and technology to be used for

consulting or remote patient care.

Telemedicine is being used in a variety of medical

related areas such as radiology, cardiology, surgery,

home health and oncology.

Recognizing Value in HITTelemedicine (cont’d)

Uses for Telemedicine:• video-conferencing• dispensing medications• blood pressure checks• glucose monitoring• ECG on demand • wound care• updated treatment plans • allows physicians to consult on various procedures from different countries


Wireless Technology: Benefits

• Advances in wireless technology have become important tools in HIT

• Wireless technology allows for formerly stationary IT systems to become mobile via cellular and WiFi connections

• Allows improved accessibility to areas of hospitals previously not accessible (e.g. OR)


Wireless Technology: Benefits (cont’d)

• Allows real time communications which can lead to improvement in care team interactions

• Can increase patient safety and improve patient care through workflow improvements


Wireless Technology: Limitations

• Reliability variances

• Accessibility variances

• Lack of standards for coverage and speed in areas of hospitals

• Cost/budgetary constraints/lack of funding sources


Implementation of Wireless Technology

Requires:

• Thorough site surveys to ensure in areas of installation that wireless signals will be accessible and reliable in the targeted area of use.

• Site survey should be done before a design plan is developed and implemented.


Implementation of Wireless Technology (cont’d)

Requires:

• Evaluation of organizational needs to ensure proper wireless infrastructure will meet established needs-current and future.

• A well planned wireless infrastructure can accept new technologies with only minimal changes to the current design.

Realizing Value from HIT

Benefits Measurement Program

Realizing value from HIT is not always easy, either in

measurement or assessment. Traditionally, the Return

on Investment (ROI) model has been the standard for

determining whether a new process, piece of

equipment or technology is value-added to an

organization. Realizing value has, for the most part,

been seen in terms of bottom-line cost reductions.


Benefits Measurement Program (cont’d)

However, measuring the value from HIT is not that

cut and dry. Other models for realizing value need

to be employed in organizations who have or will

adopt HIT applications.

Realizing Value from HITBenefits Measurement Program (cont’d)

One approach to realizing value from HIT is by

implementing a benefits measurement program. In

their article “Measuring IT Benefits: Let Us Count

the Ways", David Greenwalt and Steven Riney

suggest that there are four steps to this approach.


•Identifying benefits and metrics prior to project funding or approval

•Determining baseline measurements

•Performing a benefits opportunity analysis

•Performing a post-implementation benefits audit


First, the key benefits the organization expects to

achieve from implementing the new solution and

which metrics will best determine whether the

project has met its goals should be identified. The

benefits should be those that most closely represent

the organizations strategic direction. Ideally, there

should not be more than 12 identified benefits for

which effectiveness is measured.



Once the benefits and metrics have been identified,

a baseline for each metric needs to be calculated.

Clarifying the definitions and calculations of each

metric while determining the baseline will be useful

in mitigating discussions post implementation during

the benefits realization phase.



In performing a Benefits Opportunity Analysis, one

should look to established best practices, however,

in reality, there are few standards for best practices.

To determine the opportunity for achieving any

individual benefit, and organization should do four

things.



•Identify any national standards or benchmarks.

•Review any published studies by similar organizations.

•Evaluate the methods used to obtain these results.

•Balance these factors with the organization's own culture and capability.



Finally, a post implementation benefits audit needs

to be conducted. This is probably the most critical

step in assessing IT implementations, as the real

value in building a plan is measuring against it and

learning from the differences.



These authors also propose that the three main reasons IT-related investments fail to deliver value are as follows:

•Poor alignment of processes and technology

•Inadequate process change

•A lack of executive ownership and accountability


ROI (Return on Investment) vs. Value

• Focus on “Value” instead of ROI.

• True “Value” can be recognized by an organization if a change to an integrated leadership model is made.

• Integrated leadership involves collaboration among IT professionals, clinical professionals and financial officers.


ROI (Return on Investment) vs. Value (cont’d)

• Involves a common goal and a willingness of all parties to listen to each others’ perspectives.

• Power struggles need to be left at the door and joint decisions need to be made for the good of the organization.

• Needs to be a proactive process instead of a reactive process.

New Capabilities in Health Information Technology (HIT)

Electronic Health RecordsAdvances in EHR applications extend the depth and

breadth of record keeping by having the ability to store:

• Email• Voicemail• Scanned Images• Recorded interviews, which is especially helpful in

mental health• Patient photos (before and after)


Telemedicine

Advances in telemedicine applications extend the

physician’s capabilities through computer/robotic

solutions.

This is particularly exciting for parts of the country

that can’t attract or retain highly trained specialists

due to lack of population and/or advanced

facilities.


Health Information Exchanges (HIEs)

Development and expansion of HIEs will do much to

serve the public good in the following ways:

• Tracking drug seeking activity

• Identifying and tracking child abuse

• Identifying infections by monitoring patient data

Conclusion

As can be seen from the previous slides, there are a

variety of ways to recognize value in and realize

value from health information technology.

Advances in these fields will also offer new

opportunities for advancing patient care. This field

will continue to grow and advance, especially with

incentives such as those included in the ARRA of

2009.

Conclusion (cont’d)

Other businesses and industries are far ahead of the

healthcare industry in terms of IT adoption, and

there is a need to bring healthcare into the 21st

century. If one looks at healthcare in its most

fundamental form, it is an “information” business,

so recognizing the value in and realizing the value

from HIT is critical as we move forward with

healthcare reform in the United States and

globally.

REFERENCES

Agency for Healthcare Research and Quality (2006). Costs and Benefits of Health Information Technology. Retrieved on November 10, 2009. Link available at http://www.ahrq.gov/downloads/pub/evidence/pdf/hitsyscosts/hitsys.pdf.

AMA (2009). Risks and Benefits of Health Information Technology (Health IT). Retrieved on November 10, 2009. Link available at http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/health-information-technology/putting-hit-practice/selecting-hit/risks-benefits-hit.shtml.

Ankerstjerne, W. D., & Rehman, M. (2009). Wireless technologies. In Health Informatics Series: Anesthesia Informatics, Springer: NY, pp. 425-436

Arlotto, P., et al. (2007). Chapter 2-Healthcare information technology as a strategic asset: A framework for value management. In Arlotto, P., Birch, P. C., Crockett, M. H., Irby, S. P., (2007). Beyond return on investment: Expanding the value of healthcare information technology. Chicago, IL: Healthcare Information and Management Systems Society, pp. 7-14.

Greenwalt, D., Riney S. (2007). Measuring IT benefits: let us count the ways. Healthcare Financial Management, 61(2), pp. 86-92.

Healthcare Information and Management Systems Society (2009). Electronic Health Record. Retrieved on November 10, 2009. Link available at http://www.himss.org/ASP/topics_ehr.asp.

Healthcare Information and Management Systems Society (2009). HIMSS Health Information Exchange (HIE). Retrieved on November 10, 2009. Link available at http://www.himss.org/asp/topics_rhio.asp.

Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., and Taylor, R. (2005). Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs. Health Affairs, 24(5), pp. 1103-1117.

myPHR (2009). What is a PHR? Retrieved on November 10, 2009. Link available at http://www.myphr.com/index.php/start_a_phr/what_is_a_phr/.

REFERENCES

National ePrescribing Patient Safety Initiative (2009). FREE electronic prescribing…for every physician in America. Retrieved on November 10, 2009. Link available at http://www.nationalerx.com/.

Telemedicine.com: http://www.telemedicine.com/whatis.html

U.S. Department of Health and Human Services (2004). HHS Fact Sheet--HIT Report At-A-Glance. Retrieved on November 10, 2009. Link available at http://www.hhs.gov/news/press/2004pres/20040721.html.

U.S. Department of Health and Human Services (2009). Recovery Programs: Health Information Technology (HIT). Retrieved on November 10, 2009. Link available at http://www.hhs.gov/recovery/programs/index.html#Health.

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